Press Room

Breast cancer accounts for 30 percent of new cancer diagnoses, approximately 5,000 residents live with Down syndrome

(BOSTON—10/29/2024) This week the Massachusetts Senate passed two bills expanding services that must be covered by health insurers in the state.

One requires that insurers provide coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services. The other requires insurers provide coverage for diagnostic examinations for breast cancer.

“Down syndrome and breast cancer are different in many ways, but are the same in that the impact both conditions have on individuals and families is profound and long lasting,,” said Senate President Karen E. Spilka (D-Ashland). “Today the Senate took action requiring insurers to cover tests and treatments so that Massachusetts residents don’t have to shoulder costs related to these conditions on their own. We are prioritizing the health and wellbeing of our residents, and it is thanks to the work of Chair Rodrigues, Chair Friedman, Senator Lovely, Senator Rush, and Senator Cyr, who have each done tremendous work on these pieces of legislation.”

“The Senate has been steadfast in redefining and expanding access to quality health care, and mandating insurance coverage in numerous sectors across the health care spectrum continues that mission,” said Senator Michael J. Rodrigues (D-Westport), Chair of the Senate Committee on Ways and Means. “Senate bill 617 is a commonsense bill enabling individuals with Down syndrome to have services like speech therapy, occupational therapy, physical therapy, and applied behavior analysis services covered. It is not only the right thing to do but is also long overdue. With House bill 4918, we will now require health insurance providers to cover breast cancer diagnostic examinations, digital breast tomosynthesis screening, and medically necessary breast magnetic resonance imaging screenings as part of their list of covered services. This legislation will go a long way in the fight against breast cancer.”

“I firmly believe that insurance coverage should never be a barrier to seeking and receiving comprehensive and evidence-based medical treatment,” said Senator Cindy F. Friedman (D-Arlington), Senate Chair of the Joint Committee on Health Care Financing. “One bill passed by the Senate today requires insurance coverage for therapies to treat individuals with a singular diagnosis of Down syndrome, helping to reduce financial stressors for families and ensure these individuals receive necessary interventions to help them thrive. The other bill passed by the Senate covers breast cancer screenings and diagnostic examinations, removing the financial barriers that could otherwise prevent early detection and treatment of beatable cases of breast cancer. The Massachusetts Senate will continue to work to address challenges to equitable health care access to ensure we can improve the lives of those who stand to benefit the most from these life-changing treatments.”

Requiring Coverage for Breast Cancer Screenings

H.4918, An Act relative to medically necessary breast screenings and exams for equity and early detection, requires health insurance providers, including the Group Insurance Commission (GIC) and MassHealth, to provide coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening, and medically necessary and appropriate screening with breast magnetic resonance imaging. Although access to routine preventive screening mammograms is currently covered under the Affordable Care Act, this legislation would go further and require coverage for certain screenings and exams currently not uniformly covered by law.

According to the Massachusetts Department of Public Health (DP), breast cancer was the leading cancer among Massachusetts females between 2016 and 2020, accounting for over 30 per cent of all new cancer diagnoses in the state, afflicting more than 30,000 individuals. 4,010 Massachusetts residents lost their lives to breast cancer in that time period.

According to the American Cancer Society, when breast cancer is localized and detected early, the five year relative survival rate is 99%.

“I am grateful to see this legislation, which I have worked on for nearly a decade, move forward,” said Senate Assistant Majority Leader Joan B. Lovely (D-Salem). “Early detection of breast cancer saves lives. This legislation makes those diagnostic exams used for early detection accessible and affordable, giving women the vital resources needed to catch breast cancer in its earliest stages. With this bill we are bolstering the Commonwealth’s commitment to providing higher quality, more equitable, and more accessible healthcare for women.”

“We know that in the fight against cancer, early detection is absolutely vital for the long-term success of the patients,” said Senate Majority Whip Michael F. Rush (D-Boston). “We also know that for one out of every ten women, initial mammogram screenings are not sufficient to detect possible indicators of breast cancer. This legislation passed by the Senate today ensures that all women in the Commonwealth have access to the digital breast tomosynthesis and MRI screening they need to catch cancer early without facing financial barriers. I’m grateful to Senator Lovely and House Chair James Murphy for their championship on this issue, and to my colleagues in the Senate, particularly President Spilka and Chairman Rodrigues, for their unending support for women’s issues and the fight against breast cancer.”

A previous version of this bill having passed the House of Representatives, the two branches will now reconcile the differences between the bills before sending it to the Governor’s desk.

Requiring Certain Coverage for Down Syndrome Treatment

S.617, An Act relative to applied behavioral analysis therapy, requires health insurance providers to provide coverage

for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services.

According to UMass Memorial Health, approximately 5,000 people in Massachusetts live with Down syndrome.

According to studies performed by the American Speech-Language-Hearing Association, speech therapy intervention improved decoding skills for word reading and had a positive impact on articulation in children with Down syndrome.

“Every child deserves a fair shot at learning, growing, and thriving in their community—and that includes children with Down syndrome,” said Senate Assistant Majority Whip Julian Cyr (D-Provincetown). “Applied Behavioral Analysis therapy has proven transformative for so many; yet too often, access to this essential support is out of reach for those who need it most. By ensuring insurance coverage for at-home ABA therapy, this legislation will make a powerful difference for families across the Commonwealth, lifting a burden that has existed for too long. It’s about time we make this gold-standard care accessible to all, so every child has the chance to realize their fullest potential.”

Having been passed by the Senate, the bill now goes to the House of Representatives for consideration.

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